Childhood overweight is a concerning public health disorder that is associated with numerous medical complications, tracks into adulthood, and is difficult to treat. Childhood overweight and excess weight gain have been linked to increased intake of sugar sweetened beverages and juice, an important finding given the rising consumption of these beverages by US children and the increasing portion sizes of commercially sold beverages. Increased intake of sugar sweetened beverages may be an important dietary behavior through which overweight (prone) children achieve positive energy balance. However, family-based behavioral interventions for early childhood overweight have not been developed that specifically target reduced sugar sweetened beverage and juice intake. Such interventions, if effective, could provide a novel approach for overweight prevention and/or treatment in young children. On the other hand, it is possible that some children may "compensate" for the missing calories of non-caloric beverages (either by increasing intake of foods or untargeted caloric beverages) or that their desire for "restricted" caloric beverages may increase in response to treatment. These questions merit rigorous investigation. As a first step in this direction, the proposed study would use the R21 mechanism to develop and test a "Beverage Choice and Lifestyle Modification" (BCLM) intervention that targets 4 to 7 year old children who are at-risk for overweight or overweight and consume large amounts of sugar sweetened beverages. The 6-month, 16-session BCLM intervention will target reducing sugar sweetened beverage and juice intake by children and parents using strategies to promote non-caloric beverage choices ("substitutes ) to help achieve energy balance. Sixty families will be randomized to either BCLM (N=30) or a Nutrition Education (NE) (N=30) control group. Primary outcome measures will be quantitative (ie, changes in child BMI/percent overweight, beverage and food choices, and total energy intake) and qualitative (ie, treatment satisfaction and acceptability ratings). Secondary analyses will test the extent to which children in BCLM compensate by increasing intake of foods or untargeted beverages or increase their preference for targeted sugar sweetened beverages. Correlations between changes in parent and child beverage intakes also will be tested. Results will help design and power a larger-scale R01 application. PUBLIC HEALTH RELEVANCE: Children who consume excess amounts of sugar sweetened beverages (such as fruit juices or regular sodas) are more likely to be overweight than children who consume less sugar sweetened beverages. This research study would develop and evaluate a new "Beverage Choice and Lifestyle Modification" treatment for 4 to 7 year old overweight children and their parents. The intervention will teach lifestyle skills to promote healthier (less caloric) beverages to improve children's weight status.